Provider Demographics
NPI:1023390614
Name:HALAGAO, IMEE CABERTO (RPT)
Entity type:Individual
Prefix:MS
First Name:IMEE
Middle Name:CABERTO
Last Name:HALAGAO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-1814
Mailing Address - Country:US
Mailing Address - Phone:513-316-6948
Mailing Address - Fax:
Practice Address - Street 1:1218 KANSAS ST
Practice Address - Street 2:
Practice Address - City:DOWNS
Practice Address - State:KS
Practice Address - Zip Code:67437-1404
Practice Address - Country:US
Practice Address - Phone:785-454-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist